Monitoring the overuse and underuse of services for our Medicare members

Performing credentialing and recredentialing activities

Assessing member and provider satisfaction

Program outcomes

Each year, we check to see how close we are to meeting our goals. Here's what we did in 2018:

We collected data on a set of clinical measures called the Healthcare Effectiveness Data and Information Set (HEDIS®*), as applicable. We shared the results with the National Committee for Quality Assurance (NCQA) Quality Compass®.** The NCQA makes the results public. Each year, we use the results to set new goals and improve selected measures. As a result, performance has improved on many measures.

We asked members and providers how satisfied they are with Aetna. To improve satisfaction, we:

Your behavioral health needs are important to us

Even as the opioid crisis continues to claim lives and harm families and communities across the country, Aetna is seeing progress on stemming the tide of opioid misuse. We also continue to help our members with their mental health needs.

The multi-pronged strategy, which includes collaboration with key industry and other stakeholders, is working. Progress in 2018 included:

A decrease in the average amount of opioids prescribed per month††

A significant increase in the percentage of members with chronic pain treated with non-opioid approaches like physical therapy and non-steroidal anti-inflammatory drugs††

For members struggling with opioid use disorder, we’ve increased the use of evidence-based treatment which includes counseling and medications. This helps our members to find an effective path to end misuse.

Increased awareness and distribution of naloxone, a rescue medication for opioid overdoses, allowing members to learn to live without opioids

Expanded the Institutes of Quality (IOQ) program for substance use disorder treatment to sixteen facilities

Grew our Utilization Management Transformation (UMT) to 274 programs

UMT referrals increased to address social determinant needs and peer support

*HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
**Quality Compass is a registered trademark of NCQA.1Based on results from the 2017 Aetna Case Management Member Satisfaction Analysis.2Based on results from the 2017 Aetna Disease Management Member Satisfaction Analysis.